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BACKGROUND: Optic neuritis (ON) is an inflammatory demyelinating condition of the optic nerve, with various causes. Its incidence is higher in children and young adults than in older adults of both genders, but is more common in women than in men. ON is rarely associated with mydriasis, and it is seldom triggered by vaccines against tetanus and diphtheria. CASE REPORT: A 36-year-old Caucasian woman presented with bilateral ON that had started 18 days after administration of a booster dose of the double adult vaccine (dT) against diphtheria and tetanus. Bilateral mydriasis persisted after treatment and clinical resolution of the ON. She experienced severe headache, blurred vision, decreased visual acuity in the right eye and bilateral mydriasis, a diagnosis confirmed by imaging tests. Treatment with oral corticosteroids resulted in rapid resolution of the neuritis; however, mydriasis persisted for several months. CONCLUSION: This study describes a very unusual case of bilateral ON associated with prolonged mydriasis after vaccination against tetanus and diphtheria that regressed after treatment with oral corticosteroids. Prolonged mydriasis was the manifestation that differed from the other cases previously described.

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ABSTRACT Objective: To verify whether there are pathological dysfunctions in the cornea of patients with endometriosis. Methods: Case-control research with a quantitative approach that compared topographic and tomographic examinations of the cornea of patients with a laparoscopic diagnosis of endometriosis, without the use of hormonal medications, to the control group. Results: We analyzed 78 eyes, 34 from the endometriosis group and 44 from the control group. The loss of orthogonality between the axes of the corneal curvatures was more frequent in the group with endometriosis (p = 0.0744). The difference between the mean keratometric measurements of the two eyes was significantly greater in the control group (p = 0.0204). In the tomographic findings, the group with endometriosis presented higher means of posterior elevation compared to the control group (p = 0.0060). Conclusion: The results do not allow us to conclude that women with endometriosis have a higher risk of developing corneal ectasia, although the posterior elevation map demonstrated a greater posterior curvature of the cornea in this group, with a statistically significant difference. However, an isolated increase in the posterior elevation map does not have good diagnostic accuracy.

RESUMO Objetivo: Verificar se há disfunções patológicas na córnea de pacientes portadoras de endometriose. Métodos: Pesquisa do tipo caso-controle de abordagem quantitativa, que comparou exames topográficos e tomográficos da córnea de pacientes com diagnóstico laparoscópico de endometriose, sem uso de medicações hormonais, ao grupo controle. Resultados: Foram analisados 78 olhos, 34 do grupo com endometriose e 44 do grupo controle. A perda da ortogonalidade entre os eixos das curvaturas corneanas foi mais frequente no grupo com endometriose (p = 0,0744). A diferença entre as médias das medidas ceratométricas dos dois olhos foi significativamente maior no grupo controle (p = 0,0204). Nos achados tomográficos, o grupo com endometriose apresentou maiores médias de elevação posterior em relação ao controle (p = 0,0060). Conclusão: Os resultados não permitem concluir que portadoras de endometriose têm maior risco de desenvolver ectasia corneana, embora o mapa de elevação posterior tenha demonstrado maior curvatura posterior da córnea nesse grupo, com diferença estatisticamente significativa. Contudo, um aumento isolado no mapa de elevação posterior não possui boa acurácia diagnóstica.

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ABSTRACT Objective To analyze and describe the coefficients found on maximum Ambrósio Relational Thickness-Maximum (ART-Max) and Belin/Ambrósio Enhanced Ectasia Display total deviation (BAD-D) in eyes with normal corneal topography subjected to cataract surgery with premium intraocular lens implantation and correlated these data with final visual acuity. Methods ART-Max and BAD-D data from 103 eyes of patients subjected to implantation of diffractive bifocal intraocular lens, with normal corneal topography who achieved visual acuity of 20/20 or 20/25 without correction after cataract surgery were analyzed. The groups with normal and abnormal values were compared using the chi-square test. Results Thirty-two (31.1%) and 71 (68.9%) eyes presented normal and abnormal ART-Max values, respectively. The difference between these groups was significant (p=0.0002). Fifty-five (53.4%) and 48 (46.6%) eyes had normal and abnormal BAD-D, respectively, and intergroup difference was not significant (p=0.9576). Conclusion Among patients with normal corneal topography who underwent premium intraocular and had good final visual acuity of 20/20 or 20/25, suspicious or abnormal indices of ART-Max and BAD-D were frequent, providing evidence that it possibly should not be a contraindication.

RESUMO Objetivo Analisar e descrever os coeficientes numéricos encontrados nos exames Ambrósio Relational Thickness-Maximum (ART-Max) e desvio total do Belin/Ambrósio Enhanced Ectasia Display (BAD-D) em olhos com topografia normal submetidos ao implante de lente intraocular premium na cirurgia de catarata, correlacionando-os com a acuidade visual final pós-operatória. Métodos Foram analisados os resultados de ART-Max e BAD-D de 103 olhos de pacientes submetidos ao implante de lentes bifocais difrativas, que apresentavam exame topográficos normal e alcançaram acuidade visual 20/20 ou 20/25 sem correção visual no pós-operatório final. Para a análise estatística entre os grupos normais e anormais ou suspeitos, utilizou-se o teste do qui-quadrado. Resultados Foram encontrados 32 (31,1%) olhos com ART-Max normal e 71 (68,9%) com ART-Max suspeito/anormal. A diferença entre os grupos foi significativa (p=0,0002). Quanto ao BAD-D, foram encontrados 55 (53,4%) olhos com resultados normais e 48 (46,6%) com resultados suspeitos/anormais. A diferença entre os grupos não foi significativa (p=0,9576). Conclusão Entre os pacientes com topografia normal submetidos ao implante de lentes premium e que alcançaram acuidade visual 20/20 ou 20/25, os índices suspeitos ou anormais de ART-Max e BAD-D eram frequentes, não se configurando em contraindicação para a realização do implante.

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OBJECTIVE: To assess whether the non-contact air-puff tonometer (NCT) is an appropriate alternative to the Goldmann applanation tonometer (GAT) for measuring intraocular pressure (IOP). PATIENTS AND METHODS: An observational, cross-sectional, and comparative study with a quantitative approach was carried out. Two techniques for IOP measurements using the standard GAT and the NCT were compared. A total of 180 eyes from 90 patients were included in the study. RESULTS: The total mean IOP according to NCT measurements was 14.12 mmHg, and the total mean IOP according to the GAT was 12.98 mmHg; these values were significantly different (p=0.0018). When dividing the participants into three groups according to the measurement range obtained and comparing the mean NCT and GAT measurements in each group, in Group 1 (10-15 mmHg), no statistically significant difference was found between the means of the two tonometers (p=0.3100), a difference was observed between Group 2 (16-19 mmHg) and Group 3 (20 mmHg or more) (p<0.001). When dividing the participants by age group, the means obtained by the two tonometers also differed significantly between Group 4 (40-59 years) and Group 5 (60 years or more) (p<0.0001). In all groups, the mean measurements by the NCT were higher than those by the GAT. CONCLUSION: The NCT presented an approximate mean of the measures with the GAT in group 1 but was overestimated in the measurements of the groups 2 and 3.

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ABSTRACT Ocular toxoplasmosis frequently presents as necrotizing retinochoroiditis and, less often, as peripapillary chorioretinitis and/or papillitis. The progression from papillitis to peripapillary retinochoroiditis has been rarely described. We report the case of a 52-year-old patient living in southern Brazil, who developed papillitis in the right eye and was treated with systemic corticosteroids (prednisone 0.6 mg/kg/day and pulse therapy with methylprednisolone 15 mg/kg/day, for 3 days). After 14 days, the patient developed peripapillary retinochoroiditis with vitritis and decreased visual acuity (20/60), and was immediately initiated on the classic oral treatment for toxoplasmosis, consisting of pyrimethamine (50 mg/day), sulfadiazine (4 g/day), folinic acid (15 mg every 3 days) and prednisone (0.6 mg/kg/day). The visual acuity of the right eye normalized after treatment (20/20), which lasted approximately 70 days, but scotomas were detected on visual field examination, especially in the lower nasal quadrant. Although two studies mentioned this presentation, our report emphasizes the possible manifestation of ocular toxoplasmosis as papillitis in the initial phase, with progression to peripapillary retinochoroiditis and permanent visual field defects, which justifies early treatment for toxoplasmosis in suspected cases, especially in endemic regions.

RESUMO A toxoplasmose ocular manifesta-se com maior frequência por um quadro de retinocoroidite necrotizante e, com menor frequência, por coriorretinite justapapilar e/ou papilite. A evolução de papilite para retinocoroidite justapapilar raramente foi descrita. Apresenta-se o relato de caso de uma paciente de 52 anos, habitante da Região Sul do Brasil, que iniciou com quadro de papilite em olho direito, sendo tratada com corticoides sistêmicos (prednisona 0,6/mg/kg ao dia e pulsoterapia com metilprednisolona 15mg/kg ao dia, por 3 dias), mas, após 14 dias, evoluiu para retinocoroidite justapapilar, com vitreíte e diminuição de acuidade visual (20/60), sendo imediatamente instituído o tratamento via oral clássico para toxoplasmose, com pirimetamina (50 mg ao dia), sulfadiazina (4 g ao dia) e ácido folínico (15 mg a cada 3 dias), e mantida a prednisona (0.6 mg/kg/dia). A acuidade visual do olho direito normalizou após o tratamento (20/20), que durou em torno de 70 dias, porém desenvolveu escotomas ao exame de campo visual, sobretudo de quadrante nasal inferior. Embora tenham sido encontrados dois trabalhos que mencionam essa forma de apresentação, o presente relato destaca-se por enfatizar a possibilidade de manifestação da toxoplasmose ocular por meio de papilite na fase inicial, que evolui com retinocoroidite justapapilar, causando defeito permanente de campo visual, justificando que se avalie a instituição de tratamento precoce para toxoplasmose dos casos suspeitos, sobretudo em região endêmica.

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ABSTRACT Objective: The objective was to evaluate the efficacy of gabapentin in the management of neuropathic pain in patients with keratoconus, who were treated with fast (10 minutes) epi-off corneal crosslinking (CXL). Methods: This was a prospective, double-blind, randomized study. The sample comprised patients with bilateral progressive keratoconus, aged 12 years or older, who underwent a bilateral epi-off corneal CXL (fast - 10 minutes) procedure. One group was given placebo orally, and the other group received gabapentin 600 mg orally, both preoperatively. The visual analogue scale (VAS) was applied to record postoperative pain up to 48 hours after procedure. The study was conducted at the Belotto Stock Centro Oftalmológico, in the city of Joaçaba, Santa Catarina, Brazil, from June 2018 to September 2019. Results: At no point in the study significant differences were observed between groups, in terms of pain intensity measured by means of the VAS questionnaire, or of opioid use (Paco®), though opioid consumption was 21% lower in the group receiving gabapentin. Conclusion: We concluded gabapentin has no efficacy in postoperative pain control after epi-off corneal CXL (fast - 10 minutes). Although there was no statistically significant difference, the group that received gabapentin suffered less pain, resulting in lower opioid consumption. UTN number: U1111-1256-0330.

RESUMO Objetivo: Avaliar a eficácia do uso da gabapentina no manejo da dor neuropática em pacientes portadores de ceratocone submetidos ao tratamento de crosslinking corneano epi-off fast de 10 minutos. Métodos: Tratou-se de pesquisa prospectiva, duplo-cega, randomizada. A amostra foi composta de pacientes com ceratocone progressivo bilateral, a partir dos 12 anos de idade, submetidos ao procedimento de crosslinking corneano acelerado epi-off fast de 10 minutos bilateral. Um grupo recebeu placebo via oral e o outro, gabapentina 600mg, via oral, ambos no pré-operatório. A Escala Visual Analógica foi aplicada para registrar a dor pós-operatória até 48 horas após o procedimento. A pesquisa foi realizada no período de junho de 2018 a setembro de 2019 em um centro oftalmológico. Resultados: Não foram observadas diferenças estatísticas significativas para ambos os grupos, tanto na intensidade da dor medida pela Escala Visual Analógica, como na redução do uso do opioide (Paco®), em qualquer horário analisado durante um período de 48 horas. No entanto, houve redução de 21% no consumo de opioides pelo grupo que fez uso da gabapentina. Conclusão: A gabapentina não demonstrou eficácia no controle da dor no pós-operatório do crosslinking corneano epi-off fast de 10 minutos. No entanto, observou-se que, mesmo não havendo diferença estatisticamente significativa, houve diminuição da dor no grupo em que foi usada a gabapentina, resultando na redução do consumo de opioides. Número UTN: U1111-1256-0330.

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PURPOSE: To evaluate whether Accelerated CXL for 10 minutes is as effective as standard CXL for 30 minutes for the treatment of progressive keratoconus. PATIENTS AND METHODS: Eighty-two eyes of 62 patients with keratometry examinations performed before and 6 months after surgery were studied. A total of 39 eyes underwent standard CXL with UVA irradiation of 3 mW/cm2 for 30 minutes and 32 eyes underwent Accelerated CXL UVA irradiation of 9 mW/cm2 for 10 minutes. The eyes of all patients had corneal thicknesses of at least 450 microns (400 microns after epithelium removal). RESULTS: The means of the keratometry measurements in the preoperative period for the eyes subjected to standard CXL were 46.27 dioptres (D) on the flat axis (K1) and 48.93 D on the steep axis (K2). Postoperatively, K1 was 46.21 D and K2 was 48.97 D, a difference without statistical significance (p = 0.47 and p = 0.48, respectively). In the Accelerated CXL protocol, the preoperative measurements were 44.55 D and 46.19 D for K1 and K2, respectively. In the postoperative period, K1 was 43.37 D, and K2 was 46.64 D (p = 0.38 and p = 0.27, respectively). In the standard group, the mean maximum keratometry (Kmax) preoperatively was 55.87 D, with no statistical significance (p = 0.29). In the preoperative period, the Kmax of the Accelerated group was 51.15 D, with no statistical significance (p = 0.32). CONCLUSION: Based on the keratometry results, the accelerated protocol was as effective as the standard protocol for keratoconus stabilization.

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BACKGROUND: Ocular allergy is a common disease, especially in the pediatric population, with unpleasant and long-term consequences, including corneal complications and decreased visual acuity. This study reports two cases of corneal shield ulcer due to vernal keratoconjunctivitis, with good results of surgical debridement performed after failure of long-term clinical treatment. Furthermore, this study highlights that this therapeutic approach, although less common, is efficient in treating refractory cases that cause suffering in pediatric patients. CASE PRESENTATION: The first patient was a 7-year-old Caucasian boy with chronic ocular allergy, especially photophobia, who had been treated with eye drops, antihistamine, and corticosteroids for 60 days without success. Biomicroscopy of the right eye showed the presence of gelatinous limbus, giant papillae in the tarsal conjunctiva, and a shield ulcer measuring 6.0 mm vertically and 2.7 mm horizontally. Surgical debridement was performed, and the ulcer did not recur. The second patient was a 4-year-old Caucasian boy with chronic ocular allergy, especially itching and photophobia, who had been treated with eye drops for 1 year without success. Biomicroscopy of the left eye showed a shield ulcer, with a dense central corneal plaque, measuring 8 mm vertically and 3.5 mm horizontally. Surgical debridement of the ulcer was performed immediately because of the chronicity of the case and severity of the lesion, and the treatment was effective. CONCLUSIONS: The treatment of shield ulcers caused by vernal keratoconjunctivitis in the two reported cases was curative and definitive by surgical debridement in the 7-month follow-up period. Therefore, the early debridement of shield ulcers refractory to drug treatment can considerably reduce the time of disease evolution and the probability of ocular complications caused by clinical treatment or disease chronicity. However, this approach is rarely described in the literature and needs to be included in the ophthalmologist's therapeutic arsenal.

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Objetivo: Descrever os atendimentos oftalmológicos realizados em uma unidade geral de pronto atendimento. Métodos: Estudo prospectivo, observacional e descritivo cuja coleta de dados foi realizada em prontuários de pacientes atendidos na unidade por queixas oftalmológicas no período entre julho e novembro de 2018. Resultados: Foram revisados 445 prontuários de pacientes oftalmológicos, representando 2,18% do número total de pacientes atendidos no período. Foram encontrados 182 (40,89%) pacientes com diagnóstico de conjuntivite, 139 (31,23%) de trauma ocular e 78 (17,52%) com outros diagnósticos. Dentre os pacientes com trauma ocular, 115 (82,73%) eram do sexo masculino e 42 resultaram de acidente de trabalho. Conclusões: Conclui-se que a maioria dos pacientes oftalmológicos foi atendida com diagnóstico de conjuntivite ou trauma ocular e parte desses não faziam uso de EPI no momento da ocorrência. Os resultados permitem inferir que os médicos plantonistas precisam ter noções sobre as doenças oftalmológicas prevalentes na unidade de pronto atendimento e que desponta a necessidade de se promover campanhas para a prevenção de acidentes de trabalho junto às empresas da região, acompanhadas de fiscalização, para reduzir o acometimento de pacientes com trauma ocular resultante da não observância das normas de proteção.

Objective: To describe the ophthalmologic services performed in a general emergency care unit. Methods: Prospective, observational and descriptive study whose data collection was performed on medical records of patients seen at the unit for eye complaints in the period between July and November 2018. Results: 445 medical records of ophthalmological patients were reviewed, representing 2,18% of the number total number of patients seen in the period. 182 (40.89%) patients were diagnosed with conjunctivitis, 139 (31.23%) with ocular trauma and 78 (17.52%) with other diagnoses. Among the patients with ocular trauma, 115 (82.73%) were male and 42 resulted from an occupational accident. Conclusions: Most ophthalmologic patients were treated with a diagnosis of conjunctivitis or ocular trauma and part of them did not use PPE at the moment of the accident. The results allow us to infer that physicians on duty need to have knowledge about the ophthalmological diseases prevalent in the emergency care unit and that there is a need to promote campaigns for the prevention of work accidents with companies in the region, accompanied by inspection, reducing the involvement of patients with eye trauma who were not obeying the rules of protection.

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PURPOSE: To evaluate the effectiveness of phacoemulsification for the prophylaxis of a glaucomatous crisis in the affected and contralateral eyes; to investigate the evolution of intraocular pressure levels after iridotomy and phacoemulsification; to assess the need for antiglaucoma medication after the proposed treatments; and to identify potential complications associated with phacoemulsification. PATIENTS AND METHODS: This retrospective observational study evaluated 22 eyes of 12 patients between September 2006 and September 2018, with a minimum follow-up period of 9 months. RESULTS: After iridotomy, a persistent increase in intraocular pressure was observed in 42.85% of the cases, 100% of the patients required antiglaucoma medications, and recurrence of angle closure was observed in 28.57% of the cases. In contrast, during follow-up of phacoemulsification, the intraocular pressure levels in all eyes evaluated remained normal, without the need for medication, and no recurrence of the glaucomatous crisis or other complications was observed. CONCLUSION: Phacoemulsification maybe consequently more effective than laser iridotomy for the resolution of angle-closure glaucoma and particularly for preventing its relapses.